Pattern and management of maxillofacial fractures in Jordanian children and adolescents

Background: The aim of this study was to analyze the characteristics, etiology and treatment of maxillofacial fractures among children and adolescents in northern part of Jordan. Material and methods: A retrospective cohort study which included 91 children and adolescents patients who were treated for maxillofacial fractures during a period of three years between January 2019 and December 2021 at a tertiary hospital in Jordan. Results: Over a period of three years, a total of 91 children between the age of 0 and 19 years were treated with 156 total maxillofacial fractures. Of these, 68 (74.73%) were males and 23 (25.27%) were females. One tenth of patients (10 (10.99%) were children of the preschool group and 55 patients (60.44%) were adolescents. Road traffic accident (RTA) was the most common cause of maxillofacial fractures, accounting for 57 (62.64%) of cases. Mandibular fractures were the most common and accounted for 82 (90.2%) of all fractures, followed by the zygomatic bone fractures 40 (44%). The most common treatment was intermaxillary fixation (IMF) with 53 (33.97%) fractures. Conclusions: Maxillofacial fractures are predominant among adolescents in comparison to children. RTA was the most common cause of maxillofacial fractures, mandibular fractures were the most common fractures, and intermaxillary fixation (IMF) was the most common treatment modality. (AU)

Perfil epidemiológico de pacientes con fractura mandibular tratada quirúrgicamente en el Hospital Gustavo Fricke, Chile, entre los años 2014 y 2020 / Epidemiological profile of patients with mandibular fracture corrected surgically at the Gustavo Fricke Hospital, Chile, between 2014-2020

Introducción: Las fracturas mandibulares alcanzan un alto porcentaje en Chile. La complejidad de este tipo de fractura radica en características particulares de estas, como lo son su diversidad de presentación, diagnóstico y tratamiento. También se debe considerar las propiedades particulares del hueso mandibular, como lo son su anatomía, fisiología y dinámica. Una mejor comprensión epidemiológica de la población afectada por fracturas mandibulares permitirá proponer protocolos de atención más eficientes para estas lesiones, implementar medidas preventivas y, junto con esto, posibilitar la optimización de recursos en el sistema de salud. Objetivo: El objetivo de este estudio busca describir el perfil epidemiológico de los pacientes con fractura mandibular intervenidos quirúrgicamente en el Hospital Gustavo Fricke (HGF) de la ciudad de Viña del Mar, Chile, entre los años 2014 y 2020. Metodología: Estudio descriptivo transversal, efectuado mediante revisión retrospectiva de una base de datos anonimizada, la que reúne información de fichas clínicas y protocolos quirúrgicos de pacientes atendidos entre los años antes mencionados. Se obtuvo una muestra de 147 pacientes, los que presentaron un total de 225 fracturas mandibulares. De esta muestra se analizaron las variables sexo, edad, previsión de salud, hábitos del paciente, localización anatómica y factor etiológico, mes y día en que el paciente fue ingresado, horas de espera previas a la cirugía y días totales de hospitalización. (AU)

Introduction: Mandibular fractures reach a high percentage of prevalence in Chile. The complexity of this type of fractures lies in it’s own characteristics such as his physiology, dynamics, diversity of presentation, diagnosis and treatments. A better epidemiological understanding of the population affected by fractures of the mandibular bone will help improve care protocols for these injuries, implement preventive measures and together with this an optimization of resources of the health system. Objective: The aim of this study is to describe the epidemiological profile of patients with mandibular fracture treated at the Dr. Gustavo Fricke Hospital (HGF) in the city of Viña del Mar between 2014 and 2020. Methodology: A cross-sectional descriptive study was carried out from an anonymized data base that gathers information from surgical protocols and clinical records of 147 patients treated between 2014 and 2020, who presented a total of 223 fractures of the mandibular bone. From this sample the variables sex, age, health insurance, habits, fracture site and etiology, month and day of entry, hours before surgery and total days of hospitalization were analyzed. (AU)

Nota técnica: planificación virtual 3D en el tratamiento de fractura doble en mandíbula atrófica / Technical note: 3D virtual planning for atrophic mandible double fracture reduction

El uso de la planificación virtual ha demostrado en varios estudios una mayor predictibilidad de los resultados quirúrgicos, así como una reducción del tiempo quirúrgico y la posibilidad de comparar nuestros resultados con los esperados mediante una comparación con un TC postoperatorio. En esta nota técnica se describe cómo planificar de forma virtual la cirugía mediante tecnología 3D “in house” de fracturas en mandíbulas atróficas usando un software de uso libre. (AU)

The use of virtual planning has demonstrated in several studies greater predictability of surgical results, as well as a reduction in surgical time. In addition, we have the possibility to compare our results with the planning through a comparison with a postoperative CT. This technical note aims to describe how to plan surgery for fractures in atrophic mandibles using pre-surgical 3D technology and a free software. (AU)

Fracturas patológicas de mandíbula en pacientes adultos mayores: presentación de una serie de 15 casos / Pathological fractures of the mandible In elderly patiens. a series of 15 cases

INTRODUCCIÓN: Las fracturas patológicas de mandíbula representan menos del 2 % del total de las fracturas de mandíbula y frecuentemente afectan a pacientes adultos mayores. En pacientes mayores de 65 años estas fracturas podrían presentar características diferentes a las de la población general por su asociación con múltiples comorbilidades. MATERIALES Y MÉTODOS: Presentamos un estudio descriptivo retrospectivo de una serie de 15 casos de fracturas patológicas de mandíbula. Solo se incluyeron pacientes mayores de 65 años y se recolectaron las siguientes variables: sexo, edad, etiología, localización, tratamiento y complicaciones postoperatorias. Además se llevó a cabo una revisión de la literatura en PubMed acerca de fracturas patológicas de mandíbula. RESULTADOS: La edad promedio fue de 72 años (rango: 65-85) y el 67 % (n = 10) de los casos fueron pacientes de sexo femenino. La etiología más frecuente fue la osteonecrosis asociada a medicamentos (ONAM) (40 %). La tasa de complicaciones postoperatorias fue del 53 % (8/15). En la revisión de la bibliografía se identificaron 24 artículos acerca de fracturas patológicas de mandíbula. Solo tres publicaciones incluyen más de 10 PACIENTES: Ninguna incluye pacientes adultos mayores exclusivamente. CONCLUSIONES: En nuestra serie encontramos que la etiología más frecuente fue la ONAM. Estos pacientes pueden ser tratados de forma exitosa siguiendo los algoritmos propuestos para la población general, aunque la tasa de complicaciones es elevada (53 %)

INTRODUCTION: Pathological fractures of the mandible account for fewer than 2 % of all mandibular fractures and often affect elderly patients. In patients over 65 years of age, these fractures may present features that are different from those observed in the general population because of their association with multiple comorbidities. MATERIALS AND METHODS: In this paper, we present a retrospective study of a series of 15 cases of pathological fractures of the mandible. Only patients over 65 years old were included, and the following variables were collected: sex, age, etiology, localization, treatment and postoperative complications. Additionally, we conducted a literature review in PubMed on pathological fractures of the mandible. RESULTS: The mean age was 72 years (range 65-85) and 67 % (n=10) were female patients. The most common etiology was medicine-related osteonecrosis of the jaws (40 %). The postoperative complication rate was 53 % (8/15). We identified 24 articles assessing pathological fractures of the mandible in our review of the literature. Only three articles included more than 10 patiens. None of them related exclusively to elderly patients. CONCLUSIONS: In our series, the most frequently encountered etiology was medicine-related osteonecrosis of the jaws. These patients can be treated successfully following the same algorithms used in the general population, albeit the complication rate is high (53 %)

Fractura mandibular tardía post exodoncia de molares inferiores. Caso clínico / Late mandibular fracture after lower third molar extraction: a case report

La extracción del tercer molar es un procedimiento común en cirugía oral. Una de las complicaciones es la fractura mandibular. Con una incidencia postoperatoria menor a un 0.005%. Los factores que contribuyen al riesgo de fractura del ángulo mandibular después de una extracción del tercer molar incluyen el nivel de impactación, la anatomía del diente, infecciones locales previas, edad, sexo, presencia de formaciones quísticas y bruxismo entre otras. Presentamos un caso clínico de fractura mandibular postoperatoria a las cinco semanas tras la exodoncia del 47 y 48 incluidos en posición horizontal. El objetivo final del tratamiento de una fractura mandibular es la consolidación ósea manteniendo la oclusión dental. En nuestro caso, al no tratarse de una fractura que sobrepasaba las corticales y sin desplazamiento mandibular, no fue subsidiaria de un tratamiento quirúrgico y se resolvió con reposo funcional

The lower third molar extraction is a common procedure in oral surgery. One of its complications, although uncommon, is the mandibular fracture. Postoperatively, it has an incidence lower than 0.005%. The factors that may contribute to the risk of the mandibular angle fracture after an extraction of the third molar include the level of impaction are the anatomy of the tooth, previous local infections, age, sex, cysts and bruxism among others. We present a clinical case of postoperative mandibular fracture at five weeks after the extraction of 47 and 48 included in horizontal position. The ultimate treatment goal of a mandibular fracture is to reach a bone consolidation with the premorbid dental occlusion. In our case, as it was not a fracture that surpassed the cortical and there was not a mandibular displacement, it was not need a surgical treatment so it was resolved with functional rest

Tratamiento de las fracturas subcondíleas y de cuello de cóndilo mandibular mediante abordaje intraoral endoscópicamente asistido / Treatment of subcondilar and condilar neck mandibular fractures by the intraoral endoscopically-assisted approach

INTRODUCCIÓN: El tratamiento de las fracturas de cóndilo sigue generando controversia, optándose en la mayoría de los casos por reducciones cerradas con tratamientos subóptimos. Presentamos nuestros resultados en 26 pacientes con fracturas subcondíleas o de cuello de cóndilo mandibular tratados mediante abordaje intraoral endoscópicamente asistido. MATERIAL Y MÉTODO: Seguimiento prospectivo observacional de 26 pacientes que fueron atendidos en nuestro Servicio de Cirugía Oral y Maxilofacial del Hospital Universitario Virgen del Mar de Cádiz, desde marzo de 2010 hasta enero de 2018. De estos 26 pacientes, 23 fueron hombres y 3 mujeres, con una edad media de 29 años. RESULTADOS: De los 26 casos operados, 6 fueron fracturas de cuello y 20 fueron fracturas subcondíleas. Todos los pacientes salieron de quirófano con la boca abierta, una oclusión estable y buena apertura oral. La complicación más importante fue una infección que se resolvió con antibioterapia. Discusión: Nuestro equipo ha seguido la filosofía de otros autores de abordar todas las fracturas de cóndilo, incluso aquellas con un desplazamiento menor de 10°, atendiendo a la premisa de que si no se bloquean otras fracturas no desplazadas mandibulares que previamente a la introducción de placas de osteosíntesis se bloqueaban, ¿por qué hemos de realizar esta práctica en las fracturas de cóndilo, con la consiguiente agresión a la articulación?. CONCLUSIÓN: La reducción abierta con abordaje intraoral asistido por endoscopia constituye una técnica segura, reproducible y eficaz en la mayor parte de las fracturas extracapsulares

INTRODUCTION: The treatment of condylar fractures continues to generate controversy, opting in most cases for closed reductions with suboptimal treatment. We present our results in 26 patients treated by endoscopically assisted intraoral approach as treatment for subcondylar and neck condyle fractures. MATERIAL AND METHOD: Prospective observational follow-up of 26 patients who were treated at our Oral and Maxillofacial Surgery Service at the Virgen del Mar University Hospital of Cádiz from March 2010 to January 2018. Of these 26 patients, 23 were men and 3 women, with an age average of 29 years. RESULTS: Of the 26 operated cases, 6 were neck fractures and 20 were subcondylar. All the patients came out of the operating room with their mouths open, a stable occlusion and good oral opening. The most important complication was an infection that resolved with antibiotic therapy. Discussion: Our team has followed the philosophy of other authors to address all condylar fractures, even those with a displacement of less than 10°, following the premise that, if other non-displaced mandibular fractures are not blocked prior to the introduction of osteosynthesis plates were blocked, why should we perform this practice in the fractures of condyle with the consequent aggression to the joint?. CONCLUSION: Open reduction with endoscopic assisted intraoral approach is a safe, reproducible and effective technique in most extracapsular fractures

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Modelos de impresión tridimensional en la planificación preoperatoria y en la enseñanza académica de las fracturas mandibulares / Three-Dimensional printing models in the preoperative planning and academic education of mandible fractures

Introducción y Objetivo: Los constantes avances de la ciencia han permitido materializar imágenes de diseño para la creación de objetos físicos tridimensionales en un abanico de aplicaciones diversas. Su uso en Medicina ha sido rápidamente difundido con resultados inimaginables, con la creación de modelos anatómicos reales. El alto costo y poco acceso a las impresoras estereolitográfícas nos obliga a buscar otras alternativas de menor costo para la impresión de modelos tridimensionales de buena calidad y definición. La aparición del las impresoras por tecnología de modelado por deposición fundida (FDM) ha permitido incorporar el uso de modelos de menor costo, más accesibles y más disponibles para el ámbito de la Medicina. Presentamos y evaluamos el uso de la impresión tridimensional con tecnología FDM en la fabricación de modelos en tres dimensiones (3D) que puedan ser usados en la planificación preoperatoria de fracturas de mandíbula y en el entrenamiento de residentes. Material y Método: Estudiamos 8 pacientes con fracturas mandibulares. La evaluación incluyó la realización de tomografía computarizada. Las imágenes digitales tomográficas fueron convertidas a formato STL (estereolitográfico) y posteriormente llevada a cabo la impresión en ácido poliláctico con el uso de una impresora FDM (modelado por deposición fundida) de código abierto fabricada en Uruguay. Los modelos obtenidos fueron evaluados rigurosamente en un ámbito académico y usados para el entrenamiento de los residentes en habilidades manuales y en la planificación preoperatoria de los pacientes. Se realizó el análisis detallado de las fracturas, efectuando la selección y premoldeado de placas y tornillos de osteosíntesis para la fijación de las mismas. Resultados: Obtuvimos modelos a escala real en proporción 1:1. Todas las mediciones fueron concordantes, las placas premoldeadas se adaptaron perfectamente al paciente en el intraoperatorio y los tornillos seleccionados fueron precisos en las longitudes seleccionadas. El tiempo anestésico-quirúrgico se redujo un 20%. Residentes y docentes se mostraron satisfechos con el uso de los modelos para la discusión clínica de los pacientes y para la planificación preoperatoria, destacando las ventajas de manipular modelos hápticos frente imágenes. Conclusiones: Creamos modelos de bajo costo, buena calidad, confiables y precisos, para la planificación preoperatoria de fracturas mandibulares, logrando reducir los tiempos operatorios y mejorando la enseñanza académica en la formación de residentes de Cirugía Plástica

Background and Objective: The constant advances of science have allowed materializing images for the creation of three-dimensional physical objects in a range of diverse applications. Its use in Medicine has been rapidly disseminated with unimaginable results, with the creation of real anatomical models. The high cost and little access to stereolithographic printers forces us to look for other lower cost alternatives for the printing of three-dimensional models of good quality and definition. The emergence of the printers with fused deposition modeling (FDM) technology has allowed incorporating the use of models of lower cost, more accessible and more available for the medicine field. We present and evaluate the use of three-dimensional printing with FDM technology in the manufacture of models in three dimensions (3D) that can be used in the preoperative planning of mandible fractures and in the residents training. Methods: We studied 8 patients with mandible fractures. The initial assessment included computed tomography imaging study, and the digital file was processed into stereo lithography format. After this, the model was printed in polylactic acid using an open source fused deposition modeling (FDM) technology printer manufactured in Uruguay. The resulting models were carefully evaluated and used for academic training. Different pre-operatory approaches were studied, analyzing fracture patterns and enabling a precise selection of osteosynthesis plates and screws according to the characteristics of each patient. Results: We achieved a real scale with a 1:1 proportion models. All measurements were concordant, pre-bended plates were perfectly adapted to the patient during surgery, and the screws had an accurate longitudinal measure. Total operative time was 20% reduced. Plastic Surgery teachers and residents were satisfied using the models for preoperative clinical discussion and planning, emphasizing the advantage of manipulating real scale models compared to three-dimensional imaging. Conclusions: We have created models of low cost, high quality and accuracy, for the pre-operatory planning of mandible fracture reconstruction, accomplishing to reduce surgical time and improving the academic learning of the plastic surgery residents

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Spontaneous fractures of the mandible concept & treatment strategy

BACKGROUND: Spontaneous fractures of the mandible dispose a surgical challenge in comparisons to fractures caused by trauma due to several complicating factors. Additionally: controversies exist concerning the terminology of the field. MATERIAL AND METHODS: We conducted a retrospective study of all patients with mandibular fractures, with exclusion of fractures of the coronoid process and the alveolar process, treated at the Department of Oral and Maxillofacial Surgery, Aalborg University Hospital, Denmark between February 2003 and February 2013. Data collected from the medical records included sex, age, cause of fracture, site of fracture, and treatment. RESULTS: We identified 517 patients with 684 mandible fractures. Twenty-five of these were spontaneous fractures and 659 fractures were of traumatic origin. Condylar fractures rarely occur spontaneously, but constitute the majority of the traumatic fractures. Excluding these fractures from the analysis, we found a non-surgical approach in 14 of 24 (58%) of the spontaneous fractures and 110 of 376 (29%) of the traumatic fractures. This was statistically significant. CONCLUSIONS: We found a statistical significant difference in favor of non-surgical approach in spontaneous fractures and we discussed the treatment challenges of these fractures. We addressed the terminological controversies regarding pathological fractures, and suggested the term spontaneous fractures denoting a fracture occurring during normal jaw function being either pathological or non-pathological

Epidemiological analysis of mandibular fractures treated in Sao Paulo, Brazil / Análisis epidemiológico de fracturas mandibulares tratados en Sao Paulo Brasil

Objective. To analyze the results of an epidemiological study of mandibular fractures treated in a population of the city of Sao Paulo, Brazil. Materials and Methods. The population included patients treated by a Department of Oral and Maxillofacial Surgery and Traumatology from January 2008 to September 2010, diagnosed with mandibular fractures. The variables analyzed for the study were gender, age, etiology, clinical signs and symptoms, type of treatment, and postoperative condition. Results. A total of 171 patients and a total of 269 mandible fractures were diagnosed, with the majority being the males (84.8%), between the 2nd and 3rd decade of life. The mandibular condyle was the most affected region (32.04%), followed by the mandibular angle (23.38%). The postoperative edema was the most evident clinical sign, and the treatment of choice was the reduction and internal fixation with titanium mini-plates in all cases. Conclusion. The treatment of mandibular fractures should be aimed at restoring the occlusion and mastication function, with surgery being the most indicated treatment, using reduction and internal fixation with the use of a plates and screws system based on the experience of the authors. Knowledge of surgical techniques and methods of reduction and fixation of fractures, and periodic monitoring allow these patients to receive the appropriate treatment (AU)

El Objetivo. Analizar los resultados de un estudio epidemiológico de las fracturas mandibulares tratadas en una población de la ciudad de Sao Paulo, Brasil. Materiales y Métodos. La población incluyó a pacientes tratados por un Departamento de Cirugía Oral y Maxilofacial y Traumatología desde enero 2008 hasta septiembre 2010, con diagnóstico de fracturas mandibulares. Las variables analizadas para el estudio fueron: sexo, edad, etiología, signos clínicos y síntomas, el tipo de tratamiento y la condición post-operatoria. Resultados. Un total de 171 pacientes fueron diagnosticados de fracturas mandibulares y un total de 269 fracturas, siendo los varones, el género más afectado (84,8%), entre la segunda y tercera década de la vida, el cóndilo mandibular fue la región más afectada (32,04%), seguido por el ángulo de la mandíbula (23,38%). El edema postoperatorio fue el signo clínico más evidente y el tratamiento de elección fue la reducción y fijación interna con miniplacas de titanio en todos los casos. Conclusión. El tratamiento de fracturas mandibulares debe estar dirigida para restaurar la función de la oclusión y la masticación, siendo la cirugía el tratamiento más indicado, a través de la reducción y fijación interna con el uso de placas y tornillos de sistema basados en la experiencia de los autores Conocimiento de las técnicas quirúrgicas y los métodos de reducción y fijación de fracturas y el seguimiento periódico de los pacientes permiten un tratamiento adecuado para estos pacientes (AU)

Epidemiología de las fracturas mandibulares tratadas quirúrgicamente en el Instituto Traumatológico de Santiago (Chile): 10 años de revisión / Epidemiology of surgically treated jaw fractures in the Traumatology Institute of Santiago (Chile): a 10-year review

Los traumatismos en Chile son la tercera causa de muerte en la población general y la primera entre jóvenes. Se ha reportado una epidemiología variable alrededor del mundo asociada a diferencias demográficas y socioculturales, con escasos estudios en Latinoamérica. Objetivo. Conocer la epidemiología de las fracturas mandibulares en el Instituto Traumatológico de Santiago, Chile. Material y método. Estudio retrospectivo descriptivo de tipo cuantitativo en el Servicio de Cirugía Maxilofacial del IT, consistente en la recolección de datos mediante revisión de fichas clínicas de pacientes operados por fracturas mandibulares entre enero de 2001 y diciembre de 2010. Los datos fueron recopilados utilizando una base de datos Microsoft Access 2007 y luego tabulados y graficados con Microsoft Excel 2007. Resultados. De un universo de 783 fracturas faciales, 240 fichas de fracturas mandibulares operadas estuvieron disponibles para su análisis. La proporción hombres:mujeres fue de 5,9:1 y el grupo etario más afectado fue aquel entre 20 y 29 años. Las agresiones por terceros fueron su causa más frecuente. La mayoría de los pacientes fueron tratados en un promedio de 8,6 días desde su ingreso. En conclusión, estos resultados en general son concordantes con la literatura, salvo asociaciones entre sitio anatómico afectado y etiología (AU)

The traumatic injuries in Chile are the third cause of death in the general population and the first in young people. Their epidemiology varies around the world, and is linked to demographic and sociocultural differences, with few studies in Latin America. Objective. To determine epidemiological profile of the jaw bone fractures in the Traumatology Institute (IT) of Santiago, Chile. Material and method. Retrospective descriptive and quantitative study was conducted in the Maxillofacial Surgery Department of the IT, developed by recording data from a review of clinical records of patients with surgicaly treated jaw fractures. Data were collected between January-2001 and December-2010 using Microsoft Access 2007© and then tabulated and plotted using Microsoft Excel 2007©. Results. Out of a total of 783 facial fractures, 240 clinical files of surgically treated jaw fractures were available for analysis. The male:female ratio was 5.9:1, and the most afected age group was between 20 and 29 years old. The most frequent cause of the fracture was aggressions. Most patients were treated in an average of 8.6 days from admission. In conclusion, these results are consistent with the literature, except for the associations between the affected anatomical site and etiology (AU)

Influence of perioperative dexamethasone on delayed union in mandibular fractures: A clinical and radiological study

BACKGROUND: The aim was to clarify the occurrence of delayed union after surgical treatment of mandibular fracture and investigate whether an association exists between perioperative use of dexamethasone and delayed union. MATERIAL AND METHODS: Thirty-seven patients were included in a prospective randomized study. Of these patients, 19 (51.4%) were randomized to receive a total dose of 30 mg of dexamethasone and 18 (48.6%) served as controls. Patients underwent clinical and radiological investigation immediately, one month, three months and six months postoperatively. Radiographs were evaluated by an experienced, blinded senior oral radiologist. RESULTS: DElayed fracture union was found in 9 patients (24.3%). It was associated significantly with angle fractures (p = 0.012). Delayed union occurred more frequently in patients who received dexamethasone (36.8%) than in those who did not (11.1%) (p = 0.068). The association of infection with delayed union was significant (p = 0.027). Moreover, dexamethasone was significantly (p = 0.019) associated with delayed fracture union with concomitant infection. Gender, age group, smoking habit, treatment delay and duration of surgery were not associated with delayed union. CONCLUSIONS: Infection was associated with delayed union. Short-term high-dose dexamethasone predisposed to complicated fracture union, especially in patients with angle fractures. The relationship between dexamethasone and delayed bone healing without infection remains unresolved

Complications in the treatment with alveolar extraosseous distractors. Literature review

BACKGROUND: To review the literature that analyses the types and frequency of complications associated with the use of extraosseous alveolar distraction from 2007 to 2013. MATERIAL AND METHODS: Review of the literature in PubMed, using these keywords; alveolar ridge, alveolar distraction osteogenesis, complication, literature review. Inclusion criteria were: articles published between 2007 and 2013 that included the distraction protocol, the complications encountered and the time when they occurred. RESULTS: According to the above criteria, 12 articles were included in this review, where 334 extraosseous distractors were placed and 395 complications were encountered, of which 19 (4.81%) were intraoperative, 261 (66.07%) postoperative and 115 (29.11 %) were postdistraction. The most common complication was the incorrect distraction vector found in 105 cases (26.58%), in 23 cases (5.82%) there were severe complications, of which 14 (3.54%) were mandibular fracture and 9 (2.27%) were fractures of the distractor elements. CONCLUSIONS: According to this review, although alveolar distraction is a safe and predictable technique, it can cause complications; however, they are usually minor and easily resolved without affecting the treatment outCome

Mandibular trauma treatment: a comparison of two protocols

OBJECTIVES: The aim of this study was to evaluate the treatment of mandibular fractures treated in two European centre in 10 years. Study DESIGN: This study is based on 2 systematic computer-assisted databases that have continuously recorded patients hospitalized with maxillofacial fractures in two centers in Turin, Italy and in Amsterdam, the Netherlands for ten years. Only patients who were admitted for mandibular fractures were considered for this study. RESULTS: Between 2001 and 2010, a total of 752 patients were admitted at Turin hospital with a total of 1167mandibular fractures not associated with further maxillofacial fractures, whereas 245 patients were admitted at Amsterdam hospital with a total of 434 mandibular fractures. At Amsterdam center, a total of 457 plates (1.5 - 2.7mm) were used for the 434 mandibular fracture lines, whereas at Turin center 1232 plates (1.5 - 2.5 mm) were used for the management of the 1167 mandibular fracture lines. At Turin center, 190 patients were treated primarily with IMF, whereas 35 patients were treated with such treatment option at Amsterdam center. CONCLUSIONS: Current protocols for the management of mandibular fractures are quite efficient. It is difficult to obtain a uniform protocol, because of the difference of course of each occurring fracture and because of surgeons' experiences and preferences. Several techniques can still be used for each peculiar fracture of the mandible

Prótesis de la articulación temporomandibular: una alternativa para la impactación del cóndilo mandibular en la fosa craneal media / Temporomandibular joint prostheses: an alternative for impacted mandibular condyle in middle cranial fossa

La luxación del cóndilo mandibular con impactación en la fosa craneal media es un proceso poco frecuente –apenas se dispone de estudios publicados. Los autores describen el primer caso publicado de luxación y fractura unilateral combinadas, tratado y reconstruido con la implantación de una prótesis temporomandibular. Se describen la conducta prequirúrgica y la postura médica de los equipos de neurocirugía, radiología y cirugía oral y maxilofacial. Se proporcionan detalles de las evaluaciones de los 2 primeros an˜ os postoperatorios, incluidos la abertura máxima interincisal, función articular, habla, sintomatología dolorosa y alimentación del paciente (AU)

The dislocation of the mandibular condyle in the middle cranial fossa is a rare condition with few reports in the literature. The authors described the first case reported of unilateral dislocation and fracture treated and reconstructed with a Temporo mandibular joint prostheses. Pre-surgical conduct, medical positions of the Neurosurgery, Radiology and Oral and Maxillofacial teams are described. Also, two years post-operative evaluations are detailed, including information regarding maximum interincisal opening, function, speech, pain and diet of the patient (AU)

Incidencia de lesiones cervicales asociadas a fracturas mandibulares aisladas causadas por agresión física / Incidence of cervical spine injuries associated with isolated mandibular fractures caused by physical aggression

Los traumatismos suprclaviculares que se asocian a las fracturas de la mandíbula pueden ser generadores de lesiones cervicales, si estas no son diagnosticadas en la evaluación integral del paciente policontundido pueden pasar desapercibidas causando complicaciones neurológicas, musculares o la muerte. Objetivo. Determinar la presentación e incidencia de las lesiones cervicales asociadas a las fracturas mandibulares. Material y métodos. Estudio tipo cohorte, observacional, prospectivo-longitudinal, donde se incluyeron 25 pacientes con diagnóstico de fractura mandibular aislada durante el periodo de mayo de 2010 a febrero de 2011, que acudieron al servicio de cirugía maxilofacial del Hospital Central «Dr. Ignacio Morones Prieto» en San Luís Potosí. Resultados. De los 25 pacientes, fueron 24 hombres y una mujer, con una edad media de 26,4 años. Los estudiantes fueron los más involucrados. El tipo de agresión física que destacó fue la violencia interpersonal por riña. El 44% de los pacientes identificó los efectos del uso de alcohol en sus agresores. Ninguno de los pacientes presentó alteraciones de sensibilidad y tuvieron una fuerza muscular normal. El tipo de lesión cervical predominante fue la anterolistesis. Radiográficamente, la dimensión de los tejidos blandos prevertebrales correspondió a las cifras promedio de los tejidos sanos, la inestabilidad cervical máxima fue de 3 mm. El diámetro de la columna de aire, fue en promedio de C1:13,28 mm, C3:11,52 mm y C6:22,04 mm. Conclusiones. Las lesiones cervicales en pacientes con fractura mandibular causada por agresión física son comunes pero suelen cursar de manera subclínica por lo que es muy importante la inspección clínica y radiográfica(AU)

Supraclavicular trauma associated with fractures of the mandible may lead to cervical spine injuries if they are not diagnosed in the comprehensive evaluation of the multiple trauma patient, and may cause subclinical or unnoticed neurological and muscular complications, and even death. Objective: To determine the presentation and incidence of cervical spine injuries associated with mandibular fractures. Material and methods: A prospective, longitudinal and observational study was performed on a 25 patient cohort diagnosed with isolated mandibular fracture during the period from May 2010 to February 2011, and who were seen in the “Dr. Ignacio Morones Prieto” hospital in San Luis Potosi (Mexico) Results: The majority of the 25 patients were students with a mean age of 26.4 years of whom 24 were male and 1 was female. The most frequent type of physical aggression was a violent interpersonal violence. The effects of alcohol on their assailants were identified by 44% of the patients. None of the patients showed any changes in sensitivity and had normal muscle strength. The type of cervical spine lesion was predominantly anterolisthesis. The prevertebral soft tissue was radiographically within normal limits and the, the dimension of the corresponded to the average figures for normal tissue, maximum cervical instability was 3mm. The mean diameters of the air column were, C1: 13.28mm, C3: 11.52mm, and C6: 22.04mm. Conclusions: Cervical spine lesions in patients with mandibular fractures caused by physical assault are common and often have subclinical course, so a clinical and radiographic evaluation is very importan(AU)

Short-term effect of zoledronic acid upon fracture resistance of the mandibular condyle and femoral head in an animal model

Objective: The aim of this study was to compare the effects in terms of resistance to fracture of the mandibularcondyle and femoral head following different doses of zoledronic acid in an animal model. Study design: A total of 80 adult male Sprague-Dawley rats were included in a prospective randomized study. The animals were randomly divided into four groups of 20 rats each. Group 1 (control) received sterile saline solution, while groups 2, 3 and 4 received a accumulated dose of 0.2 mg, 0.4 mg and 0.6 mg of zoledronic acid, respectively. The animals were sacrificed 28 days after the last dose, and the right hemimandible and the right femur were removed. The fracture strength was measured (in Newtons) with a universal test machine using a 1kN load connected to a metal rod with one end angled at 30 degrees. The cross-head speed was 1 mm/min. Later, the specimens were observed under a scanning electron microscope with backscattered electron imaging (SEMBSE).At last, chemical analysis and elemental mapping of the mineral bone composition were generated using a microanalytical system based on energy-dispersive and X-ray spectrometry (EDX).Results: A total of 160 fracture tests were performed. The fracture resistance increased in mandible and femur with a higher accumulated dose of zoledronic acid. Statistically significant differences were recorded versus the controls with all the studies groups. The chemical analysis in mandible showed a significantly increased of calcium and phosphorous to compare the control with all of the study groups; however, in femur no statistically significant differences between the four study groups were observed. Conclusions: The administration of bisphosphonates increases the fracture resistance in mandible and femur (AU)

Epidemiología de las fracturas maxilofaciales tratadas quirúrgicamente en Valdivia, Chile: 5 años de revisión / Epidemiology of the maxillofacial fractures surgically treated in Valdivia, Chile: a 5-year review

Se ha reportado en muchos países la incidencia y prevalencia del trauma maxilofacial, encontrándose diferencias entre los distintos estudios debido a factores socioculturales. Objetivo. Conocer la epidemiología de las fracturas maxilofaciales en el Hospital Base de Valdivia, Chile. Material y método. Se realizó un estudio de corte transversal entre los años 2005 y 2010, registrando todas las fracturas del servicio de cirugía maxilofacial que requerían una reducción quirúrgica. Se recopiló información de acuerdo a edad y género del paciente, tipo de fractura, localización y fecha de la intervención. El total de pacientes fue de 149, sumando un total de 172 fracturas. Resultados. El promedio de edad fue de 27,47 años (DE 10,9). La relación hombre-mujer fue de 9:1. Del total de intervenciones realizadas (n=172) un 70,4% correspondieron a fracturas mandibulares, siendo el ángulo mandibular (27,9%) la más frecuente, seguida por la paramediana (20,9%), cigomático-maxilar (3,4%) y cuerpo mandibular (11,1%). En conclusión, nuestro estudio muestra características similares a otros estudios en cuanto a población afectada. Sin embargo, la distribución de la localización de las fracturas difiere(AU)

The incidence and the prevalence of maxillofacial trauma have been reported in many countries, with differences being found between studies due to sociocultural factors. Objetive. To determine the epidemiology of maxillofacial fractures in Base Hospital of Valdivia, Chile. Material and methods. A cross-sectional study was conducted between the years 2005 and 2010, recording all fractures in the Maxillofacial Surgery Department that required surgical reduction. Information was collected according to patient age and gender, type of fracture, location, and date of the intervention. There was a total 149 patients with a total of 172 fractures. Results. The mean age was 27.47 years (SD 10.9). The male: female ratio was 9:1. Of all interventions (n=172), 70.4% were mandibular fracture, with the angle of the mandible being the most frequent (27.9%), followed by paramedian (20.9%), zygomatic-maxillary (13.4%) and mandibular body (11.1%). In conclusion our study showed similar characteristics to other studies in terms of affected population, but the distribution of the location of fractures differed(AU)

Fractura mandibular patológica por plasmocitoma intraóseo / Pathological mandibular fracture due to intraosseous plasmacytoma

Los tumores de células plasmáticas se subclasifican en: Plasmocitomas solitarios de hueso, mieloma múltiple y plasmocitoma extramedular. El 80 % de estos últimos afecta la región de la cabeza y cuello surgiendo en el tejido blando del conducto respiratorio alto y, raras veces, en la cavidad bucal. La búsqueda de una enfermedad sistémica es importante es aquellos casos en los que se haga dicho diagnóstico. Se presenta el caso de un paciente, varón de 73 años de edad, residente en la localidad rural de Gran Mogol, en Minas Gerais (Brasil), La tomografía computarizada mostró hipodensidad y reabsorción osteolítica irregular en la base de la cresta alveolar mandibular izquierda. La lesión de medición 38,0×19,0×15,0 mm. En la TC se ve claramente la presencia de fractura patológica del lado izquierdo. La aspiración con aguja se realizó, donde se obtuvo sangre. Se realizó la biopsia incisional. El diagnóstico presuntivo fue ameloblastoma. La muestra de biopsia fue enviada para análisis anatomohistopatológica. La microscopía mostró células tumorales compuesto por células monomórficas, con núcleos ovalados, grandes periféricos, y excéntricos, nucléolos prominentes y citoplasma basófilo, rodeado por estroma escaso y la infiltración de hueso esponjoso. La prueba de orina se destinó específicamente a la proteína de Bence-Jones, que fue negativo. Las radiografías de cráneo y tórax fueron realizados y no mostró cambios. Luego completó un diagnóstico de Plasmocitoma solitario en la mandíbula. El paciente está sometido a radioterapia en el Servicio de Oncología de la Santa Casa de Misericordia. El paciente tuvo mucositis severa y cambios en el color facial como resultado de la radioterapia (AU)

Plasma cell tumors are subclassified into: Solitary plasmacytoma of bone, multiple myeloma and extramedullary plasmacytoma. 80% of the latter affects the region of the head and neck soft tissue arising in the upper respiratory duct and rarely in the oral cavity. The search for a systemic disease is important in cases where the diagnosis is made. A case of a patient, a man of 73 years of age, residing in the rural village of Great Mogol, Minas Gerais (Brazil), Computed tomography showed irregular osteolytic hypodensity and resorption at the base of the left mandibular alveolar ridge. The lesion measuring 38.0 mm × 19.0 mm × 15.0 mm. On CT clearly shows the presence of pathological fracture of the left side. Needle aspiration was performed, where blood was obtained. Incisional biopsy was performed. The presumptive diagnosis was ameloblastoma. The biopsy specimen was sent for analysis anatomohistopatológica. Microscopy showed tumor cells composed of monomorphic cells with oval nuclei, large peripheral and eccentric, prominent nucleoli and basophilic cytoplasm, surrounded by scant stroma and infiltration of cancellous bone. The urine test was conducted specifically for the Bence-Jones protein, which was negative. The skull and chest radiographs were performed and showed no changes. He then completed a diagnosis of solitary plasmacytoma of the jaw. The patient is undergoing radiotherapy at the Oncology Department of Santa Casa de Misericordia. The patient had severe mucositis and changes in facial color as a result of radiotherapy (AU)